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>in many individuals,

So then why are we not working to determine which individuals it is suitable for?

What is the alternative to aspirin for this use case and who benefits?

One just finds out by trial and error, although the injury can take many months to manifest, and is slowly reversible upon cessation. As for the safer pharmaceutical alternative, clopidogrel is it, again in a sufficiently low dose, but it is not OTC.

Its probably best to talk to your doctor about a CAC score. I don't know if its possible to tell stable vs unstable plaque yet, but a higher CAC score may benefit from aspirin.

It doesn't, as it doesn't dissolve in the stomach, thanks to its enteric coating.